UNASSIGNED: Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach.
UNASSIGNED: Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical.
UNASSIGNED: The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills.
UNASSIGNED: While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula.
UNASSIGNED: This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.

Resilience is learnable and broadly described as an individual\'s adaptive coping ability, its potential value for stress reduction must be explored. With a global coronavirus pandemic, innovative ways to deliver resilience training amidst heightened mental health concerns must be urgently examined. This systematic review aimed to (1) evaluate the effectiveness of digital training for building resilience and reducing anxiety, depressive and stress symptoms and (2) to identify essential features for designing future digital training. A three-step search was conducted in eight electronic databases, trial registries and grey literature to locate eligible studies. Randomised controlled trials examining the effects of digital training aimed at enhancing resilience were included. Data analysis was conducted using the Stata version 17. Twenty-two randomised controlled trials involving 2876 participants were included. Meta-analysis revealed that digital training significantly enhanced the participants\' resilience with moderate to large effect (g = 0.54-1.09) at post-intervention and follow-up. Subgroup analyses suggested that training delivered via the Internet with a flexible programme schedule was more effective than its counterparts. This review supports the use of digital training in improving resilience. Further high-quality randomised controlled trials with large sample size are needed.